Management of onychomycosis with topicals

Of all superficial fungal infections, onychomycosis is the most difficult to manage. Practitioners of all disciplines realize its chronic nature, difficulty in eradication, and propensity to recur. Topical treatment of onychomycosis, as opposed to oral therapies, offers a distinct advantage by allowing the patient to apply medication directly to the affected area, thus decreasing the potential for serious adverse events, such as drug toxicity and drug interactions. In the past, a multitude of topical antifungal agents were used in the treatment of onychomycosis; however, an acceptable level of scientific evidence regarding their effectiveness was lacking and this was evident by poor success rates. The development of a comparatively effective topical agent, the only one so far to gain FDA approval, has renewed interest in this form of therapy. Improved versions are being developed that may overcome the shortcomings of the first approved topical agent.